The adenoids are diffuse masses of lymphatic tissue located on the nasal pharynx (high up on the throat behind the nose). In fact, the adenoid tissue is a tonsil. There are 3 pairs of tonsils in the human body - called the pharyngeal tonsils. What is commonly known as the tonsils is the palatine tonsils, a pair of oval shaped masses protruding from each side of the oral pharynx (the part of throat located behind the mouth and nasal cavity). The adenoids are the pharyngeal tonsils and the third pair of tonsils are the lingual tonsils, masses of lymphatic tissue located on the surface tissue at the base of the tongue.
Children (2 -6 years of age) are more prone to infection or inflammation of lymphatic tonsil tissue than adults. This is due to tonsil tissue in childrenbeing larger in size. This tissue decreases and degenerates as we grow older. Frequent infection can result in enlarged adenoids in both children and adults and can cause difficulty in breathing and sleep apnea.
Symptoms of enlarged adenoids
Swollen adenoids (andenoid hypertrophy) can block the nose which may result in the following symptoms.
- Snoring
- Breathing through mouth – this may result in a dry mouth
- Speech impediments with some sounds
- Nasally sounding voice
- A stuffy nose
- Changes to shape of the palate and position of the teeth
- Green or yellow discharge from the nose
Or there may be no symptoms.
First line of defence
The function of the tonsil is to prevent any pathogens which enter the body through the mouth and nose being able to cause infection in the respiratory and digestive systems. Hair and mucous in the nose filter and trap pathogens and antibodies produced by adenoid tissue destroy them. The tonsil tissue is covered in pits which lead to deeper lymphatic tissue. In the case of the lingual tonsil, small mucous glands effectively drain into deeper tissue, effectively reducing the chance of infection in this area.
Unfortunately, tonsils can collect debris and become inflamed and infected themselves. Enlargement can obstruct breathing.
Complications can include:
- Glue ear. Swollen adenoids can block the normal flow of mucous through the eustachian tubes from the inner ear. The sticky mucous builds up and can interfere with the delicate operations of the tiny bones in the inner ear – resulting in hearing loss.
- Middle ear infections. The adenoids are situated at the end of the Eustachian tube, the tube leading from the nose to the middle ear. Pathogens from infected adenoids can travel up this tube and spread into the middle ear which can result in middle ear infection and loss of hearing.
- Sinusitis. The sinuses are hollow spaces located around the skull and nasal bones of the head. Infection from the adenoids can spread into the sinuses. Symptoms may include facial congestions and pain, thick green/yellow mucous discharge, sore throat and cough, fever, loss of smell and taste, tiredness and bad breath.
- Chest infections. Bacteria from infected adenoids may spread to other areas of the body such as the bronchi in the lungs – causing pneumonia.
Common causes of enlarged adenoids
Infections. Adenoids can become enlarged due to a throat infection with a virus or bacterial. This can be more prevalent with children going to childcare or the first year at school when associating with many children.
Allergies. Seasonal or all-year-round reactions can cause enlarged adenoids. This may occur in spring and summer for seasonal or from dust mites, animal or foods.
Gastroesophageal reflux
Gastric reflux is associated with many ear, nose and throat symptoms such as chronic rhinitis, chronic cough, recurrent ear infections, asthma, reflex apnea and is a risk factor for adenoids hypertrophy. Studies have shown a higher incidence of gastric reflux disease (GERD) in children with adenoid hypertrophy. Reflux stomach material can reach the middle ear due to immature Eustachian tube development and gastric contents can cause and inflammatory cascade in the adenoids. Gastrointestinal reflux can be due to rushed eating, irritating foods or disorders of digestion. In children it may be due to an immature digestive system. GERD (gastric reflux disease) is a disorder where the top of the stomach fails to close properly after eating resulting in the stomach contents rising up (refluxing) and irritating the oesophagus.
Cancer. In rare cases.
Diagnosing enlarged adenoids
An ear, nose and throat specialist (ENT) will confirm diagnosis using a flexible, fibreoptic nasopharyngoscope (a thin tube fitted with an eyepiece, lenses, and its own light source to illuminate the field of vision).
Treatment for Infected Adenoids
Enlarged adenoids cause blockages to the eustachian tubes leading to the ears but will usually return to normal once symptoms are relieved. Antibiotics may be prescribed for bacterial infection. Surgical removal of the adenoids and often the palatine tonsils may be performed for recurring cases of infection or if breathing is obstructed from enlarged adenoids.
Preventative measure can include supporting the immune system, reducing exposure to allergens and reducing reflux.
Support the immune system
A healthy diet, good quality sleep, exercise and relaxation will help ensure a appropriate responsive immune system. Nutritional and herbal support includes:
- Vitamin D
- Zinc
- Probiotics
- Elderberry
- Eyebright
- Echinacea
Gastric reflux
Reduce reflux by eating smaller meals, limit spices, no to coffee, caffeine-based drinks, smoking and alcohol. Have a dedicated dinning time by sitting relaxed whilst eating, focusing on food and increase chewing time.
- Slippery elm
- Chamomile
- Probiotics
- Calcium
- Magnesium
Iberogast is a formula of 9 herbs for the treatment of gastrointestinal disturbances such as function dyspepsia and is suitable for babies to adults.
In the case of Allergies
Reducing reactions to allergies can be easy if the allergy is known, but in many cases it is not. Common allergy causing products include dust mites, animal dander, flora and many foods. Allergy testing can help establish what to avoid. Supporting the immune system can help encourage appropriate allergic response and recovery.
- Probiotics. Lactobacillus paracasei (LP-33®) and Lactobacillus rhamnosus GG (LGG) can help.
Chronic tonsillitis
Microbial biofilms are a major cause of repeated tonsillitis in both children and adult (and other stubborn infections). They may live on living or non-living surfaces (toothbrushes and dental braces for example) and they can be resistant to antimicrobial therapy (antibiotics).
Biofilms are communities of microorganisms which become embedded within a slimy extracellular matrix that is composed of extracellular polymeric substances (EPS). In simpler words the microorganisms form an irreversible attachment to surfaces (adenoids for example), multiply, grow, produce a protective matrix and disperse to do the same again - spreading infection which is hard to eradicate.
- N-acetyl-cysteine (NAC) is an antioxidant mediator which has been shown to reduce biofilm emergence and promotion, inhibiting the formation of bacterial biofilm. NAC effectively reduce the levels of prostaglandins, raised in infection, helping to disrupt biofilms.
- Garlic is rich in many anti-microbial compounds and has been found to have an inhibitory effect on biofilm formation on some bacteria.
- Quercetin is a plant polyphenol found in many fruits, vegetables and grains, has been reported to significantly inhibit biofilm formation.
- Tea tree oil (TTO) is known for its antimicrobial activity and data show that it is able to efficiently kills S. aureus in the stationary growth phase and within biofilms. Use it as a gargle, as an inhalation or to clean toothbrushes etc.
- Oregano and sage essential oils are effective antimicrobial agents and have been found beneficial in the management of streptococcal pharyngitis. Caution with the use of essential oils and children – follow safely guidelines.
References
- https://www.britannica.com/science/tonsil
- https://medlineplus.gov/adenoids.html#:~:text=Adenoids%20are%20a%20patch%20of,through%20the%20mouth%20and%20nose.
- https://www.msdmanuals.com/home/ear,-nose,-and-throat-disorders/mouth-and-throat-disorders/adenoid-disorders
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/adenoids
- https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/sinusitis-and-allergy
- The relationship between adenoid hypertrophy and gastroesophageal reflux disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203580/
- Towards a better understanding of Lactobacillus rhamnosus GG - host interactions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155824/
- https://www.sciencedirect.com/topics/immunology-and-microbiology/extracellular-polymeric-substance
- Chronic tonsillitis and biofilms: a brief overview of treatment modalities https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134941/
- Developing natural products as potential anti-biofilm agents https://cmjournal.biomedcentral.com/articles/10.1186/s13020-019-0232-2
- Effects of Tea Tree (Melaleuca Alternifolia) Oil on Staphylococcus Aureus in Biofilms and Stationary Growth Phase https://pubmed.ncbi.nlm.nih.gov/19095413/
- Essential Oils From Origanum Vulgare and Salvia Officinalis Exhibit Antibacterial and Anti-Biofilm Activities Against Streptococcus Pyogenes https://pubmed.ncbi.nlm.nih.gov/29452197/?from_term=ginger+and+biofilms&from_pos=3
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